Abstract [en]

Background: More knowledge is needed about outcome of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to SUDs. Objectives: To evaluate the effects of community-based psychological treatment on SUD patients’ psychosocial problems, as well as on their substance use. Design: All patients who were referred or self-referred for psychological treatment to a social worker or a psychotherapist at three outpatient treatment centers for SUD patients were asked to participate in the study. Methods: Ratings at treatment start and end were obtained on Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM, n = 100), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C, n = 49), and Drug Use Disorders Identification Test - Consumption (DUDIT-C, n = 27). Results: CORE-OM mean scores were significantly improved. In total 14% of the patients were recovered, 10% improved, and 5% deteriorated. Both AUDIT-C and DUDIT-C mean scores were significantly improved for patients with alcohol use and patients using illicit drugs, respectively. Conclusions: Routine psychological treatment had positive effects on psychological distress as well as on reduction of substance use. A substantial number of patients remained however unchanged, particularly regarding psychological distress. More studies with larger patient groups are needed to develop treatment for SUD patients in routine care.

Söderberg Gidhagen, Ylva

Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Dependency in Norrköping.

2018 (English)Doctoral thesis, comprehensive summary (Other academic)

Abstract [en]

Background: Substance use disorder is one of the most important threats to health and welfare in the world. More knowledge is needed about the outcomes of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to substance use disorders.

Aims: To evaluate the effects of community-based psychological treatment on SUD outpatients’ psychological distress and substance use, and also to analyze the importance of their attachment style and the alliance with regard to treatment outcome.

Methods: Patients who were referred or self-referred to a social worker or a psychotherapist at three outpatient treatment centers for SUD were invited to participate in the study. At each session the patients filled out an instrument measuring psychological distress, the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) and to evaluate the alliance to the therapist the Working Alliance Inventory – short form revised (WAI-SR). At treatment start and end the patient filled out the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test including the extended version (DUDIT/DUDIT-E) and the Experiences in Close Relationships – short form (ECR-S) categorizing attachment style. Therapists filled out the CORE Therapy Assessment form at treatment start and the End of Therapy form at treatment termination. After each session, they also filled out the Working Alliance Inventory – short form for therapists (WAI-S).

Results: Of the 119 patients who agreed to participate in the study, there were 100 patients who filled out two or more CORE-OM and WAI-SR forms. Outcome on substance use as measured with AUDIT-C and DUDIT-C was collected for 63 patients. The analyses showed that CORE-OM mean scores were significantly improved. In total 14% of the patients were recovered, 10% improved and 5% deteriorated. AUDIT-C and DUDIT-C mean scores were significantly improved for patients using alcohol and for patients using illicit drugs, respectively.

An insecure attachment style was more common among the patients in this research project, compared to non-clinical groups. The patients with a fearful attachment style scored higher on psychological distress than the patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. Significantly more patients had a secure attachment style at treatment end.

Previous studies have found that the associations between alliance and outcome for SUD patients may be weaker than for other clinical groups, which was confirmed in this thesis. Three moderators of the alliance-outcome association – type of substance use, attachment style and treatment orientation – were assessed. None of the potential moderators tested showed any effect on the association between alliance and psychological distress. The variance among the therapies concerning the session-to-session alliance-outcome association was considerable, indicating that other moderating variables might be found.

Conclusions: Routine psychological treatment had positive effects on psychological distress as well as on reduction of substance use. However, a substantial number of patients remained unchanged, particularly regarding psychological distress. Among patients with SUD there seems to be a strong relationship between attachment style and psychological distress. Knowledge of the patient’s attachment style may help the therapist to tailor the treatment to the patient’s needs. A change from an insecure to a secure attachment style can be an important goal for SUD treatment, as it may prevent the patient from using strategies involving substance use for regulating emotions and interpersonal relationships. This thesis confirms and strengthens the finding of a weaker association between alliance and outcome for SUD patients, compared to other clinical groups. A challenge for further research is to find factors that contribute to the alliance-outcome association among SUD patients.

Studies with larger patient groups, additional instruments and methods are needed to develop treatments for SUD patients in routine care.